Delivery of the NHS Health Check by health trainers can improve conversion into uptake of lifestyle service Dr Ifeoma Onyia Public Health Consultant Halton Borough Council

Context 1 Halton is in the North West Population of 125 000 people Circa 34 – 38 K HC eligible Delivery predominantly via primary care with community support from HIT Council based health improvement team Health trainers in community and primary care Point of care blood tests used

2 Performance Data Number Eligible Number Invited % Invited Received % Take up 2013-2014 37967 5217 14% 2179 5.7% 2014-2015 38314 7687 20% 3045 7.9% 2015-2016 34414 6922 3224 9.4% 5 year cumulative (up to Quarter 1: June 2016) Total eligible population 2013-2016 37919 Number of people who were offered a health check 21,650 Number of people who received a health check 9,136 % of people who received a health checks of those offered 42%

Using the Ready Reckoner 3 Using the Ready Reckoner

Expected outcomes: Health Conditions 4 Expected outcomes: Health Conditions   Actual Outcomes  Taken from RR 14/15 15/16 Diabetes 26 6 2 Impaired glucose 63 62 154 Hypertension 96 Incomplete data 77 Chronic kidney disease 65 CVD Risk > 20% (??) 298 require statins ( I’m using this as a proxy for high CVD score) 86 116 CVD Risk > 10% Not collected 226 Compare with national evaluation: Hypertension (1 case per 27 NHS Health Checks), cases of diabetes (1 new case for every 110 Checks) and w cases of CKD (1 new case in every 265 Checks).I calculated based on 2 years data CKD =25, BP 225 and DM 55. We use 3/12ffup not a full year

Exercise and BMI 5 Ready Reckoner expected Obese 687 Take up weight loss programme 274 Are inactive 1966 Take up exercise brief intervention 954 Actual 14/15 15/16 BMI>25   2707 2565 Taken up weight loss brief intervention 1902 1735 Taken up exercise brief advice/ referral 1169 1296

6 Smoking and Alcohol Ready Reckoner suggests 719 Smokers of which 69 referred to smoking cessation Actual 14/15 15/16 Smoker 579 490 Referred to smoking cessation 129 74 Alcohol threshold exceeded 1052 1188 Advice 865 618 Further intervention 96 101

7 Outcomes 89% of patients whose BMI status was recorded were classed as overweight or obese both years. Of these 70% were either referred for a weight management intervention or given brief advice in 14/15 and 67% in 15/16. Both years a fifth of patients were identified as being a smoker and of that number 22% were referred to smoking cessation services in 14/15 and 15% the year following. Non recording of smoking or BMI status was more common in practices with no health trainer; similarly onward referral into other lifestyle programmes was lower from practices with no health trainer.

Impact of having Health Trainer in Practice 8 Impact of having Health Trainer in Practice *Practice with a health trainer for a short period of time ** Practice with health trainer currently

9 Outcomes Continued Across two years 42% of patients received lifestyle input on alcohol. Of these 11% were referred for an alcohol intervention with the remaining given behavioural advice. 18% of those seen as part of a health check were directly referred into smoking cessation 216 individuals were enrolled in a health trainer delivered educational programme to support them with impaired glucose monitoring as a direct result of a health check Of note lower identification of CVD conditions compared to ready reckoner health trainer allows instantaneous onward referring ie its seamless

How to do it yourself 10 Health Trainers Template for data input Governance Training e.g on diagnostic tests using POCT and use of GPPAQ, QRISK2 etc Access to primary care systems Ability to check performance-data transfer A degree of freedom

11 Summary Health trainers in primary care have resulted in a measurable increase in the number of people who are accessing lifestyles services as a result of a health check. The standard of training received also provides assurance that the advice provided is of the quality and type expected. Having a small number of general practices to work with makes it an easier process to undertake. Restrictions on access to patient identifiable information limits our ability to long term track individuals and better understands long term impacts of our approach. For further information please do contact me: ifeoma.onyia@halton.gov.uk